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50 Age, histology and stage predict survival following adjuvant chemotherapy and radiation versus radiation alone in high-risk endometrial cancer: a study based on portec-3 criteria
  1. Y Casablanca1,2,
  2. C Tian1,3,
  3. M Powell4,
  4. B Winterhoff5,
  5. JK Chan6,
  6. CD Shriver2,
  7. CA Hamilton7,
  8. GL Maxwell7 and
  9. KM Darcy1,2,3
  1. 1Uniformed Services University of the Health Sciences, Gynecologic Cancer Center of Excellence, Bethesda, USA
  2. 2Uniformed Services University of the Health Sciences, John P Murtha Cancer Center Research Program, Bethesda, USA
  3. 3Henry Jackson Foundation for the Advancement of Military Medicine- Inc., Women’s Health Integrated Research Center, Annandale, USA
  4. 4Washington University St Louis, Gynecologic Oncology, St Louis, USA
  5. 5University of Minnesota, Gynecologic Oncology, Minneapolis, USA
  6. 6Palo Alto Medical Foundation- California Pacific Medical Center- Sutter Health, Gynecologic Oncology, San Francisco, USA
  7. 7Inova Fairfax Hospital and Inova Shar Cancer Institute, Gynecologic Oncology, Falls Church, USA


Objectives Evaluate the impact of age, stage and histology on survival in high-risk endometrial cancer (EC) following treatment with chemotherapy and radiation (CTRT) vs. radiation alone (RT).

Methods Eligible patients were diagnosed with high-risk EC from 2004–2014 in the National Cancer Database based on PORTEC-3 criteria and treated with pelvic beam radiation and/or radioactive implants. The CTRT group also received multiple-agent chemotherapy. A propensity score approach controlled for differences in clinical factors. Survival was evaluated using weighted Kaplan-Meier and Cox model analyses with interaction testing.

Results There were 10,009 women in the CTRT group and 10,006 in the RT group. After balancing, a 4.9% improvement in 5-year survival and a 15% drop in the adjusted risk of death was observed following treatment with CTRT vs. RT (P<0.0001). The survival benefit and reduction in the risk of death associated with CTRT vs. RT alone varied by age at diagnosis, stage and/or histology (figure 1, P<0.0001 for each interaction test) with the largest benefits at age ≥70 vs. <70 years old, with stage III vs. stage I/II disease and in serous/clear cell carcinoma vs. endometrioid carcinoma. CTRT was associated with a 20% increased risk of death in patients <70 years old with stage I/II endometrioid EC (P<0.0001).

Abstract 50 Figure 1

Survival distributions and adjusted hazard ratio (HR) and 95% confidence interval (CI) for CTRT vs. RT

Conclusions Age, stage and histology merit consideration when selecting adjuvant therapy for high-risk EC patients based on a study in 20,015 women.

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